Healthcare Provider Details

I. General information

NPI: 1659333417
Provider Name (Legal Business Name): ROSA MALNATI D.P.M.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/05/2006
Last Update Date: 10/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7205 SE MARICAMP RD
OCALA FL
34472
US

IV. Provider business mailing address

1425 S US 301
SUMTERVILLE FL
33585-5141
US

V. Phone/Fax

Practice location:
  • Phone: 352-680-7000
  • Fax:
Mailing address:
  • Phone: 352-793-5900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberPO 2746
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: